Answer
Recommended diagnostic studies to evaluate a suspected diagnosis of Waldenstrom macroglobulinemia/lymphoplasmacytic lymphoma are as follows [1] :
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History and physical examination with complete neurologic and ophthalmologic examination
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Quantitative serum immunoglobulin G, immunoglobulin A, and immunoglobulin M (IgM) (total levels of serum immunoglobulins should be assessed with nephelometry)
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Serum immunofixation
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Twenty-four–hour urine collection for protein electrophoresis
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Serum free light-chain assay
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Bone marrow biopsy with cytogenetics, fluorescence in situ hybridization (FISH) (for lymphoma and myeloma), and flow cytometry (should include CD19, CD20, CD38, and CD138)
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Serum beta2-microglobulin
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CT scanning of the chest, abdomen, and pelvis (to assess for lymphadenopathy and splenomegaly)
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Complete blood cell (CBC) count and serum chemistries
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Serum viscosity
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Autoantibodies, Coombs test, cold agglutinins, cryoglobulins, anti–myelin-associated glycoprotein (MAG) antibodies (based on history and physical finding)